June 09
C u l i n a r y N u t r i t i o n N ew s :
Allergen Awareness
Presented by ACF Chef & Child Foundation and Clemson University
S
The Big Eight
than intolerances. Being able to recognize
Every year, food allergies are responsible
the difference is critical since one may
for approximately 30,000 cases of severe
allow for minimal amounts of the given
allergic reactions, 2,000 hospitalizations,
ingredient while the other can cause a
million Americans that compose a virtually
and 150 deaths, making this not only a topic
deadly reaction with even the smallest bite
untapped market segment in the restaurant
of concern for the healthcare industry but
of the food.
world. Would you be interested in supplying
also the foodservice sector. According to the
these guests with an exceptional dining
Center for Disease Control and Prevention2
Those with food allergies usually cannot
experience at your restaurant? Most would
(CDC), food allergies affect about one to
eat any amount of that particular food
say, “Yes, just tell me how.” The only hitch
two percent of the population. However, the
without triggering a reaction. By definition
is that this particular group consists of
number of young people who have a food
an allergy is a reaction to a food that
those with food allergies. Still interested?
allergy has increased by 18 percent over the
involves the body’s immune system. The
last decade, which means that approximately
body sends antibodies, which attack the
As a chef, you know more about ingredients
3 million U.S. children and teenagers have
food and produces an immune response
than most. Therefore, equipping yourself
a food allergy. While the exact cause for
by releasing histamine that generates the
with a dash of awareness mixed in with
this increasing trend remains questionable,
allergic symptoms. These symptoms range
a pinch of careful thought and combined
building awareness of food allergies seems
from minor, such as an itchy throat, running
thoroughly with expert technique, you can
the most effective means of control and
nose, watery eyes, skin rashes, headache
create a dish for anyone with any special
prevention. Remembering all the possible
and cramping, to major, such as anaphylactic
dining consideration, such as a food allergy.
sources of food allergies is easy, considering
shock, which is when the airway swells
If your desire is to lure more people into
only eight foods account for 90 percent of
closed and hinders breathing that could
your restaurant to enjoy food that fits their
all food-allergy reactions.
result in death if not immediately treated.
more, then this is information you will not
1. eggs
Life-threatening allergic reactions can
want to miss.
2. fish (bass, cod, flounder)
be treated with the prescription drug
3. milk
epinephrine usually delivered through
4. peanuts
a pen-like device, epi-pen. Yet, as a
5. shellfish (crab, lobster, and shrimp)
foodservice worker, you should always
6. soy
call for Emergency Medical Services
7. tree nuts (pecans, almonds, walnuts)
(EMS) personnel if you notice someone
8. wheat
having an allergic reaction. Since there is
uppose there is a group of 12
2
3
needs, and keep them coming back for
no treatment for food allergies except for
Food Allergy
versus Food Intolerance
avoidance of the particular food, people
with food allergies must carefully assess
and evaluate foods, nutrition labels and
Allergy
ingredients of dishes when dining out.
Before beginning to structure a means of
Conversely, restaurants hold responsibilities
prevention in foodservice, it is important to
to those customers with food allergies,
note that food allergies are very different
which will be discussed later.
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Intolerance
Unlike an allergy, a food intolerance does
Fish and Shellfish
not involve an immunologic reaction.
• Caponata, a traditional
Therefore, those with intolerances may be
sweet-and-sour
able to eat small amounts of the particular
Sicilian relish, can
food. This guest should be aware of their
personal tolerance level. For instance,
contain anchovies.
• Caesar salad dressings
customers with lactose intolerance may
and steak or Worcestershire
be able to tolerate small quantities of
sauce often contain anchovies.
dairy products. People with lactose
intolerance lack the enzyme, lactase,
which is required to properly digest the
milk sugar, lactose. As a result, they can
experience gas, bloating and abdominal
pain when they consume milk products
in a given amount, which varies with
each individual. Lactose intolerance can
be treated by consuming lactase tablets
before consuming milk products.
Hidden Sources
If it were only as easy as specifying an egg
allergy and having a waiter or waitress who
could immediately tell you what foods are
• Surimi (imitation crabmeat) contains fish.
Milk
Tree nuts
• Deli meat slicers are frequently used for
• Artificial nuts can be peanuts that have
both meat and cheese products.
• Some brands of canned tuna fish contain
casein, a milk protein.
• Many non-dairy products contain casein
(a milk derivative), listed on the
ingredient labels.
• Some meats may contain casein as a
extra flavor.
• Artificial nuts can be peanuts that have
recognizable foods. This makes recognizing
been deflavored and reflavored with a nut,
food allergies and their sources of critical
such as pecan or walnut. Mandelonas are
importance to restaurants and food
peanuts soaked in almond flavoring.
establishments everywhere. To help bring
• Arachis oil is peanut oil.
further allergen awareness to all, the Food
• African, Chinese, Indonesian, Mexican,
Allergy & Anaphylaxis Network (FAAN)
Thai and Vietnamese dishes often contain
lists some hidden sources of food allergies
peanuts, or are contaminated with peanuts
as seen here:
during the preparation process. Additionally,
and are used in some bar drinks.
• Some commercial brands of egg
substitutes contain egg whites.
• Tree nuts have been used in many
foods, including barbecue sauce,
cereals, crackers and ice cream.
Allergy Quiz
after they have been grilled to add
food allergy sources are used in other less
or milk topping on specialty coffee drinks
are peanuts soaked in almond flavoring.
• Mortadella may contain pistachios.
• Many restaurants put butter on steaks
Peanuts
• Eggs have been used to create the foam
nut, such as pecan or walnut. Mandelonas
binder. Check all labels carefully.
void of eggs. Unfortunately, many of the
Eggs
been deflavored and reflavored with a
1.
with allergy shots.
2.
3.
True or False: Egg substitutes are always safe
to use when preparing a meal for a guest
with an egg allergy.
4.
Which of the following salad ingredients are
common food allergens?
a. Lettuce
b. Bleu cheese
foods sold in bakeries and ice cream
c. Pecan pieces
shops are often in contact with peanuts.
d. Sliced mushrooms
e. Hard-boiled eggs
5.
Ordering fried foods at a restaurant can be
• Many brands of sunflower seeds are
produced on equipment shared
with peanuts.
risky for people with food allergies because
Soy
a. Frying changes the food
b. The added fat from frying intensifies
c. Cross contamination with other food
• Soybeans and soy products are found in
pastas (including those used in prepared
baked goods, canned tuna, cereals,
foods such as soup) contain egg or are
crackers, infant formulas, sauces and soups.
processed on equipment shared with
True or False: It is okay to test if a food is safe
by taking a small bite.
• Most commercially processed cooked
True or False: Food allergies can be cured
• At least one brand of peanut butter lists
ingredients can occur
6.
What food component is responsible for an
a. Fat
individuals may safely eat soybean oil
b. Protein
for egg-containing products. Fresh
(not cold pressed, expeller pressed or
c. Carbohydrate
pasta is sometimes egg-free, too.
extruded oil).
egg-containing pastas. Boxed, dry
pastas are usually egg-free, but may be
processed on equipment that is also used
soy on the label.
• Studies show that most soy-allergic
allergic reaction?
Answers: 1. False 2. False 3. False 4. c and e 5. c 6. b
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Gluten Sensitivity
Along with discussing food allergies and
intolerances, gluten sensitivity, which affects
one out of 250 people in the United States,
is another significant topic of concern
Grain products with gluten4
that are not used in their common
• Barley: All forms, such as malt, malt
form. For example, miso and lecithin
flavoring and malt extract
• Crossbred varieties of these grains, such
as triticale (a cross between wheat and rye)
for the food industry. Gluten-sensitive
• Rye
enteropathy, also known as celiac disease,
• Wheat: All varieties, such as spelt, kamut,
is an autoimmune, inflammatory disease of
the small intestine that is triggered by the
wheat starch, wheat bran, wheat germ,
consumption of gluten. Gluten is a type of
cracked wheat and hydrolyzed wheat protein
and barley, and is responsible for the volume,
Grain products without gluten4
texture and appearance of baked goods. As
• Buckwheat
the tough, rubbery substance formed when
• Corn tortillas
wheat flour is mixed with water, gluten is
• Grits
found in a variety of food products, such as
• Millet
cookies, breads, cakes, cereals, crackers and
• Plain brown rice
many others. Unfortunately, many people are
• Plain enriched white rice
allergic to it.
• Plain popcorn
• Plain specialty rice, such as basmati
and jasmine
increasing in popularity.
dietary needs.
dinning establishments, below are safety
measures to take in order to protect them
against possible allergic reactions.5
• For gluten sensitivity, do not put
breadsticks/croutons on the meal, if
this is done accidentally do not simply
• Polenta
intestine. When the villi are damaged, the
• Quinoa
body cannot absorb nutrients. While some
• Rice cakes (check labels; not all varieties
rashes when diagnosed, others may not
diners to appropriate choices. For
When customers with allergies do visit your
projections in the lining of the small
bloating, weight loss, fatigue or painful skin
• Create special menus to help guide
• Train your staff to ask about any special
• Plain rice noodles
may experience diarrhea, abdominal pain,
know of any special needs that they have
to make sure you can accommodate them.
example, gluten-free menus are
protein that is commonly found in rye, wheat
gluten can damage villi, the finger-like
easy and quick reference.
• Encourage diners to call ahead and let you
einkorn and emmer; all forms, such as
For those diagnosed with celiac disease,
are soy derivatives.
• Have a complete list of ingredients for
brush off the crumbs.
• For tree nut, peanut and shellfish
are gluten-free)
• Rice crackers (check labels; not all
varieties are gluten-free)
allergens, do not cook the meal on a grill
or in a pan that has not been through a
dishwasher or similar washing procedure.
• For gluten sensitivity, do not place
have any symptoms. The bottom line is that
• Taco shells
items in a place where breadcrumbs
anyone diagnosed with celiac disease should
• Unseasoned corn tortilla chips
have been. This includes not toasting
gluten-free bakery items in a toaster
avoid all gluten since the smallest amount
can cause damage. Nowadays, there are all
Private practices
that has breadcrumbs in it or straining
sorts of gluten-free products, such as breads,
Diners hold the responsibility of
gluten-free pasta in strainers that also
cookies and cakes, available at supermarkets
communicating to restaurant staff any
are used for other pastas.
and specialty stores. Gluten-free flour is also
and all allergies and special considerations.
• Watch out for other forms of the allergen.
available and is usually made from blending
However, dining establishments must also
For example, some diners with peanut
flours of potatoes, legumes, rice, nuts and
take precautions to ensure the safety of
allergies will not have peanut oil while
seeds. Fortunately, being gluten-free has
their customers. Some examples of ways to
others will.
gotten a lot easier.
practice safety measures for possible food
allergies in restaurants are as follows:5
• Make sure you and your staff know
which of the big eight allergens are in
each of your menu items as well as in
your prepared items.
• When using prepared or packaged
ingredients in the kitchen, study
Dr. Margaret D. Condrasky, R.D., C.C.E.,
is an associate professor of Food Science and
Human Nutrition at Clemson University.
She leads the CU CHEFS® program for
improving culinary nutrition skills.
Marie Hegler is a graduate of the
Food Science and Human Nutrition
department with a culinary science
the ingredient list and learn
emphasis at Clemson University, which
to recognize disguised
operates the CU CHEFS® program for
ingredients or ingredients
improving culinary nutrition skills.
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About the American Culinary Federation
and the Chef & Child Foundation
For More Information
Food Allergy & Anaphylaxis Network (FAAN)
is a nonprofit organization dedicated to
bringing about a clearer understanding
The American Culinary Federation, Inc.,
established in 1929, is the premier professional
organization for culinarians in North America.
With more than 22,000 members spanning
230 chapters nationwide, ACF is the culinary
leader in offering educational resources,
training, apprenticeship and accreditation
In addition, ACF operates the most
comprehensive certification program for chefs
in the United States. ACF is home to ACF
Culinary Team USA, the official representative
for the United States in major international
culinary competitions, and to the Chef & Child
Foundation, founded in 1989 to promote
proper nutrition in children and to combat
childhood obesity. For more information,
visit www.acfchefs.org.
About Clemson University
of the issues surrounding food allergies
and providing helpful resources.
Visit: http://www.foodallergy.org/
International Food Information Council
(IFIC) Foundation communicates
science-based information on food safety
and nutrition to health and nutrition
professionals, educators, journalists,
government officials and others providing
information to consumers and recently
created Resources on Food Allergy.
Visit: http://www.ific.org/publications/
other/foodallergyresources.cfm
American Academy of Allergy Asthma
& Immunology (AAAAI) is the largest
professional medical organization in the
United States devoted to the allergy/
immunology specialty.
Visit: http://www.aaaai.org/
Celiac Disease Awareness Campaign
provides current, comprehensive,
CU CHEFS® (Clemson University’s Cooking and
Healthy Eating Food Specialists) instructional
program, led by Dr. Marge Condrasky, Associate
Professor in Food Science and Human
Nutrition, is a registered trademark of Clemson
University designed to promote changes
in menu planning, food purchasing, food
preparation and food consumption behaviors
with a goal of fostering good health through
healthy nutrition. ‘Culinary nutrition’ is the
application of nutrition principles combined
with food science knowledge displayed through
a mastery of culinary skills. The results are
healthy eating behaviors grounded in culinary
confidence and nutrition alertness. CU CHEFS®
promotes an awareness of the latest trends in
foods and nutrition through the demonstration
of proficient culinary skills to produce flavorful,
health-inspired menus for schools, churches,
restaurants. Clemson University, located in
Clemson, S.C., is ranked 22 among the nation's
top public institutions. Since 2001, Clemson has
doubled external research funding, raised the
academic profile of the student body, increased
retention and graduation rates, launched highprofile economic development and has earned
national accolades, including being named
TIME magazine's Public College of the Year.
science-based information about the
symptoms, diagnosis and treatment of
celiac disease, also known as celiac
sprue, nontropical sprue and
gluten-sensitive enteropathy.
Visit: http://celiac.nih.gov/
National Foundation for Celiac Awareness
(NFCA) not-for-profit organization to raise
awareness of celiac disease among
the general public and the healthcare
community, and to facilitate research to
better understand the causes, mechanisms
and treatment of celiac disease.
Visit: http://www.celiaccentral.org/
References
1. Report on the Expert Panel on Food Allergy
Research, June 30 and July 1, 2003, National
Institute of Allergy and Infectious Diseases,
National Institutes of Health. Available at:
http://www3.niaid.nih.gov/about/
organization/dait/PDF/june30_2003.pdf.
2. NCHS Data Brief, No. 10. Food allergy among
U.S. children: trends in prevalence and
hospitalizations. October 2008. Centers for
Disease Control and Prevention, Available at:
http://www.cdc.gov/nchs/data/databriefs/
db10.htm.
3. CDC. 2008 National Center for Chronic Disease
Prevention and Health Promotion, Division of
Adolescent and School Health. Available
at: http://www.cdc.gov/healthyyouth/
foodallergies/#2.
4. Thompson, Tricia. Celiac Disease Nutrition Guide.
2nd edition. American Dietetic Association: 2006.
5. Brown, Lisa S. Dealing with Food Allergies in a
Food Service Environment: Avoiding the Big
Eight. 2009 ACF Northeast Regional
Conference, Boston, MA.
6. Reuter, Amy J. Meeting the Challenges of
Cooking for People with Food Allergies. 2009
ACF Western Regional Conference, Seattle WA.
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